COVID-19 Medicare and Medicaid Resources

Medicare-Specific Guidance for Health Care Providers 

Effective March 1, 2020, MVP is following the payment rules published in the Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency, Interim Final Rule with Comment (IFC). 

For information about COVID-19 Testing Coding, visit our COVID-19 Practice Management page

Telemedicine for Medicare Members 

During the current State of Emergency related to COVID-19, telemedicine visits for Medicare Members will be paid at the same rate as if the visit was in person. Effective March 13, 2020, telemedicine visits billed with codes 99201-99215 with the POS code that would have been reported had the services been furnished in person, and the appropriate appended modifier, “95” or “GT”, will be reimbursed at no cost-share to the Member. This applies to all services (E/M, Mental Health Counseling, and preventive services) that would have otherwise been face-to-face. 

The following modifications have been made for the duration of the declared State of Emergency :

• Location restrictions on Originating Sites: Medicare Members can be in their home for the telemedicine visit 
• Providers may conduct telemedicine visits with a Member that is not already established (new patients) 
  
  

Providers must use an interactive audio and video telecommunications system that permits real-time communication between the Provider (“Distant Site”) and the Member (“Originating Site”). When it is possible for Covered Services to be furnished via telemedicine, MVP will pay for such services. Such services should be coded at a level of care appropriate for provision through a telemedicine mechanism. Providers should maintain documentation in the medical record for the level of care billed. MVP may request additional documentation to review and confirm such level of care. 

The following new codes should be used for telephone visits with Medicare Members to ensure cost-share is waived. More information about the Interim Final Rule can be accessed from the Federal Register’s website. 

Virtual Check-In 

Consistent with CMS guidance, Providers should bill the following G codes for all Medicare Members when conducting visits via telephone. These are the only codes that may be used for Medicare Members and will be covered at no cost-share to Members during the declared State of Emergency. Claims should include the appropriate place of service code and modifiers should be appended per appropriate coding guidelines.

Medicare E-Visits 

Medicare Part B pays for E-visits, or patient-initiated online E/M conducted via a patient portal. Providers who may independently bill Medicare for E/M visits (for instance, physicians and nurse practitioners) can bill the following codes:

Clinicians who may not independently bill for E/M visits (examples include but are not limited to: physical therapists, occupational therapists, speech language pathologists, clinical psychologists) may provide E-visits and bill the following codes. Claims should include the appropriate place of service code and modifiers should be appended per appropriate coding guidelines. 

Visit CMS.gov for a summary of Medicare telemedicine services

Medicaid-Specific Resources for Health Care Providers

• MVP Medicaid Pharmacy Billing for COVID-19 Testing (PDF)  
• MVP Pharmacy Billing Guidelines for COVID-19 Vaccines (PDF)
• MVP Medicaid Home Test Billing (PDF)
• MVP Medicaid Monoclonal Antibodies Billing Guidance (PDF)
• MVP Medicaid Oral Antiviral Pharmacy Billing Guidance (PDF)  
• MVP Medicaid Vaccine Counseling Billing Guidance (PDF)
• Medicaid Pediatric Vaccine Counseling Billing Guidance (PDF)